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Variability in Post Operative Nipple Sensation by Dermoglandular Pedicle in Bilateral Breast Reduction
Oluwaseun D. Adebagbo, BS1,
2, Benjamin Rahmani MS, BS
1, John B. Park, PharmD
1, Amy Chen, BS
1, Shannon R. Garvey, MS, BS
1, Daniela Lee, BS
1, Nimish Saxena, BA, Macie Gettings, BS, Bernard T. Lee, MD
1, Ashley Boustany, MD
1, Samuel J. Lin, MD FACS
1, Ryan P. Cauley, MD, MPH
1
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA, 2Tufts University School of Medicine, Boston, MA
Purpose: Loss of nipple sensation following reduction mammaplasty can negatively impact a patient's outcomes. Few studies have explored the association between operative techniques and postoperative nipple sensation. This study aimed to assess the adjusted effect of pedicle choice on subjective nipple sensation.
Methods: Among 659 patients undergoing bilateral reduction mammoplasty at a single institution, 182 survey responses meeting inclusion criteria were analyzed. Subjective nipple sensation outcomes were compared by pedicle type, and subgroup analysis was used to adjust by factors such as resection volume.
Results: Overall, over 92% of patients reported some subjective nipple sensation after breast reduction, however a significant proportion noted reduced sensation compared to their baseline across multiple modalities (Table1). Superior pedicles were associated with significantly decreased nipple sensitivity to light touch and temperature (p=0.0023, p=0.03) and overall nipple sensation satisfaction (p=0.05) compared to inferior pedicles). When stratified by resection volume we noted that pedicle choice was not associated with a difference in sensory outcomes for patients with resections <500 grams.
Conclusion: While a majority of patients maintain some sensation after breast reduction, a significant minority report a relative decrease in subjective sensation.
Reassuringly,
for patients with a resection volume of less than 500 grams, pedicle choice does not appear to affect sensory recovery. However when a greater resection volume is anticipated, the inferior pedicle may be associated with more favorable sensation outcomes.
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| TABLE 1. Nipple Sensation Return/Preservation by Pedicle |
| By Pedicle only | | <500 grams | >500 grams |
| Inferior | Superior | p-value | | Inferior | Superior | p-value | Inferior | Superior | p-value |
| n = 182 | 134 | 48 | - | n = 188 | 57 | 26 | | 70 | 24 | |
| Sensation Preservation |
| Not at All | 9 (7%) | 5 (10.4%) | 0.15 | Not at All | 3 (5%) | 3 (12%) | 0.45 | 6 (8%) | 2 (9%) | 0.1287 |
| A Little | 42 (31%) | 21 (44%) | | A Little | 23 (38%) | 10 (40%) | | 19 (26%) | 11 (48%) | |
| Completely | 83 (62%) | 22 (46%) | | Completely | 35 (57%) | 12 (48%) | | 48 (44%) | 10 (44%) | |
| Nipple Sensation Outcomes, n (%) |
| Light Touch |
| Insensitive/ Less Sensitive | 38 (30%) | 28 (56%) | 0.0023 | Insensitive/ Less Sensitive | 21 (37%) | 14 (54%) | 0.32 | 17 (24%) | 14 (58%) | 0.0015 |
| The Same | 63 (59%) | 19 (38%) | | The Same | 29 (51%) | 9 (35%) | | 34 (49%) | 10 (42%) | |
| Very Sensitive/ Hypersensitive | 26 (21%) | 3 (6%) | | Very Sensitive/ Hypersensitive | 7 (12%) | 3 (12%) | | 19 (27%) | 0 | |
| Change in Pressure |
| Insensitive/ Less Sensitive | 23( 18%) | 20 (40%) | 0.07 | Insensitive/ Less Sensitive | 14 (25%) | 8 (31%) | 0.32 | 15 (21%) | 12 (50%) | 0.02 |
| The Same | 74 (59%) | 22(44%) | | The Same | 35 (63%) | 13 (46%) | | 39 (56%) | 10 (42%) | |
| Very Sensitive/ Hypersensitive | 23 (18%) | 8 (16%) | | Very Sensitive/ Hypersensitive | 7 (13%) | 6 (23%) | | 16 (23%) | 2 (8%) | |
| Change in Temperature |
| Insensitive/ Less Sensitive | 19 (15%) | 15 (30%) | 0.03 | Insensitive/ Less Sensitive | 11 (20%) | 8 (31%) | 0.13 | 8 (11%) | 7 (29%) | 0.11 |
| The Same | 81 (64%) | 30 (60%) | | The Same | 34 (61%) | 17 (65%) | | 47 (66%) | 13 (54%) | |
| Very Sensitive/ Hypersensitive | 27 (21%) | 5 (10%) | | Very Sensitive/ Hypersensitive | 11 (20%) | 1 (4%) | | 16 (23%) | 4 (17%) | |
| Numbness/Tingling |
| Not at All | 94 (72%) | 32 (65%) | 0.18 | Not at All | 44 (75%) | 20 (77%) | 0.64 | 50 (70%) | 12 (52%) | 0.0098 |
| A little | 33 (25%) | 13 (27%) | | A little | 13 (22%) | 6 (23%) | | 20 (28%) | 7 (30%) | |
| Quite a Lot/ Very much | 3 (2%) | 4 (8%) | | Quite a Lot/ Very much | 2 (3%) | 0% | | 1 (1%) | 4 (17%) | |
| Nipple Pain |
| Not at All | 111 (87%) | 6 (13%) | 0.76 | Not at All | 47 (83%) | 24 (92%) | 0.08 | 64 (91%) | 17 (77%) | 0.11 |
| A little | 15 (12%) | 41 (85%) | | A little | 19 (18%) | 15 (4%) | | 5 (7%) | 5 (23%) | |
| Quite a Lot/ Very much | 1 (0.79%) | 1 (2%) | | Quite a Lot/ Very much | 0% | 16 (4%) | | 1 (1.4%) | 0 | |
| Current Touch | Current Touch | | | | | | |
| No Sensation | 8 (6%) | 8 (16%) | 0.098 | No Sensation | 3 (5%) | 5 (19%) | 0.1 | 5 (7%) | 3 (13%) | 0.28 |
| Less Pleasant | 24 (19%) | 10 (20%) | | Less Pleasant | 14 (24%) | 4 (15%) | | 10 (14%) | 6 (25%) | |
| The Same/ More Pleasant | 98 (75%) | 32 (64%) | | The Same/ More Pleasant | 42 (71%) | 17 (65%) | | 56 (79%) | 15 (63%) | |
| Pleasurable Sensation Loss |
| Not at All | 79 (63%) | 22 (46%) | 0.09 | Not at All | 33 (59%) | 11 (46%) | 0.55 | 46 (66%) | 11 (46%) | 0.13 |
| A little | 28 (22%) | 13 (27%) | | A little | 13 (23%) | 7 (29%) | | 15 (21%) | 6 (25%) | |
| Quite a Lot/ Very much | 19 (15%) | 13 (27%) | | Quite a Lot/ Very much | 10 (18%) | 6 (25%) | | 9 (13%) | 7 (29%) | |
| Change in Sexual Pleasure |
| Unchanged | 88 (72%) | 30 (65%) | 0.66 | Unchanged | 41 (71%) | 17 (71%) | 0.98 | 47 (72%) | 13 (59%) | 0.47 |
| A little decrease/ Substantial decrease | 29 (24%) | 14 (30%) | | A little decrease/ Substantial decrease | 14 (24%) | 6 (25%) | | 15 (23%) | 8 (36%) | |
| Decreased a lot/ Absent | 6 (5%) | 2 (4%) | | Decreased a lot/ Absent | 3 (5%) | 1 (4%) | | 3 (5%) | 1 (5%) | |
| Preoperative Sensation Significance |
| Unimportant / Not very important | 17 (14%) | 11 (24%) | 0.21 | Unimportant / Not very important | 10 (18%) | 6 (25%) | 0.67 | 7 (11%0 | 5 (23%) | 0.29 |
| Neither important or unimportant | 37 (30%) | 15 (33%) | | Neither important or unimportant | 18 (32%) | 8 (33%) | | 19 (29%) | 7 (32%) | |
| Important/ Very Important | 69 (56%) | 20 (44%) | | Important/ Very Important | 29 (51%) | 10 (42%) | | 40 (61%) | 10 (46%) | |
| Postoperative Sensation Significance |
| Unimportant / Not very important | 16 (13%) | 11 (24%) | 0.028 | Unimportant / Not very important | 9 (16%) | 5 (21%) | 0.84 | 7 (11%) | 6 (27%) | 0.0042 |
| Neither important or unimportant | 35 (28%) | 17 (37%) | | Neither important or unimportant | 20 (35%) | 8 (33%) | | 15 (22%) | 10 (45%) | |
| Important/ Very Important | 74 (59%) | 18 (39%) | | Important/ Very Important | 29 (50%) | 11 (46%) | | 45 (67%) | 6 (27%) | |
| Overall Nipple Sensation Satisfaction |
| Somewhat dissatisfied/ Very Unsatisfied | 14 (11%) | 8 (17%) | 0.059 | Somewhat dissatisfied/ Very Unsatisfied | 8 (14%) | 3 (13%) | 0.59 | 6 (9%) | 5 (21%) | 0.036 |
| Neither satisfied or unsatisfied | 16 (13%) | 12 (25%) | | Neither satisfied or unsatisfied | 11 (19%) | 7 (29%) | | 5 (7%) | 5 (21%) | |
| Somewhat Satisfied/ Very Satisfied | 96 (76%) | 28 (58%) | | Somewhat Satisfied/ Very Satisfied | 39 (67%) | 14 (58%) | | 57 (84%) | 14 (58%) | |
| A p-value of <0.05 was considered statistically significant. |
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